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अपना नाम :-
पिता का नाम:-
मोबाईल नम्बर
	स्टुडेन्ट् अपना अथवा अपने अभिभावक का मोबाईल नम्बर दें
जन्म की तारीख(mm/dd/yyyy):-
	click on 2011 than drop down arrow will show you previous years
लिंग	पुरुष महिला

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